Provider Demographics
NPI:1902340904
Name:YANKLOWITZ, RAYMOND ARTHUR (LADC)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:ARTHUR
Last Name:YANKLOWITZ
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 MCCREA ST
Mailing Address - Street 2:
Mailing Address - City:FORT EDWARD
Mailing Address - State:NY
Mailing Address - Zip Code:12828-1428
Mailing Address - Country:US
Mailing Address - Phone:518-415-8524
Mailing Address - Fax:
Practice Address - Street 1:202 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-2411
Practice Address - Country:US
Practice Address - Phone:866-639-9573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT151.0124297101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)